Dehydration in Newborns and Infants

Dehydration is a condition where there are not enough fluids in the body. Your baby's body is made up of approximately 75% water. Each day, your child loses fluids through urination, bowel movements, sweating, crying, and even breathing. You replace these fluids each time you feed your child. But, if your baby loses more fluids than she takes in, it can lead to dehydration. Here are the symptoms, causes, and treatment of dehydration in newborns and infants along with tips for prevention.

Babies can become dehydrated quickly. The signs of dehydration in babies to be aware of are:

• Dry lips
• Dry mouth
• Less than six wet diapers in a 24 hour period
• Concentrated urine that looks very dark yellow or orange
• No interest in taking the bottle or breastfeeding
• A sunken fontanel (soft spot) on your baby's head
• No tears when your baby is crying
• Irritability
• Excessive sleepiness

Dehydration in newborns and young infants is usually the result of not taking in enough fluids to replace what is lost in the course of the day. Older infants and children are more likely to become dehydrated from an illness. Here are some of the things that can lead to dehydration.

• Breastfeeding Issues: A breastfed newborn can become dehydrated if he's not latching on correctly, not breastfeeding often enough, not breastfeeding long enough at each feeding or there's an issue with the supply of breast milk.
• Bottle-Feeding Issues: A bottle-fed baby may become dehydrated if he's not taking a bottle often enough or he's not taking enough infant formula or pumped breast milk at each feeding.
• Refusing to Eat: A baby may refuse the breast or the bottle if he's in pain or not feeling well. A stuffy nose, earache, or a sore throat can interfere with sucking and swallowing.
• Fever: A rise in your child's body temperature can cause a greater loss of fluids. Plus, your baby may not take feedings as well when he has a fever.
• Diarrhea: If your child develops diarrhea, the loss of fluids through the bowels can be dangerous.
• Vomiting: If a baby is not able to keep down most of her feedings, she is losing important fluids that her body needs. Repeated vomiting can quickly lead to dehydration.
• Overexposure to Heat: High temperatures, extreme humidity, or spending too much time outdoors in the hot sun can cause sweating and the evaporation of fluids through your baby's skin.

If your baby is showing signs of dehydration, you should call the doctor or go to the emergency room. The treatment for infant dehydration depends on the cause and severity of the condition.

If the symptoms are mild, your doctor may tell you to begin treating your child at home and continue to carefully monitor the symptoms. You should:

• Offer a bottle or breastfeed frequently especially if the baby isn't taking in too much at each feeding.
• Keep track of your baby's feedings and wet diapers.
• If it is very warm and your baby is overheating, move to a cool place and remove excessive clothing or blankets from your child.
• Follow the doctor's instructions if he tells you to give your baby an oral rehydration fluid such as Pedialyte. However, you should not give your baby Pedialyte, water, or any medication for illness, vomiting, or diarrhea without talking to the doctor first.

If your baby is a newborn or a young infant, your doctor will want to see the baby for a check-up.

• The doctor may tell you to feed your child more often or give her more at each feeding.
• If you're breastfeeding, the doctor may want to check your baby's latch and breastfeeding technique.
• If you're breastfeeding and your baby isn't getting enough breast milk, you may have to supplement your baby with infant formula.
• The doctor may instruct you to give your baby an oral rehydration fluid such as Pedialyte.
• The doctor will also examine your child's health. If the baby has an infection, the doctor may prescribe medicine to treat the illness.
• The doctor will want to monitor the baby closely.

If the dehydration becomes severe, your child may need to go to the hospital. At the hospital the doctor can:

• monitor your baby's intake and output of fluids
• give the baby IV fluids to replace what's being lost especially if the baby is not eating well or has severe vomiting and diarrhea
• give your child medicine to treat any illness or underlying cause

Understanding dehydration can help to prevent it. Here are some tips:

1. Feed your newborn. If you're bottle-feeding, offer one to three ounces of infant formula or pumped breast milk in a bottle every two to three hours. If you're breastfeeding, put your newborn to your breast at least every two to three hours around the clock.
2. Make sure your baby is getting enough breast milk or infant formula. Keep track of the number of wet diapers your baby is having each day and see your baby's doctor for regular well-baby checkups to monitor healthy weight gain.
3. It's OK to wake a sleeping baby. If you have a sleepy newborn, wake him up to breastfeed or to take his bottle if it's been more than three hours. As the weeks go on and your baby begins to take more at each feeding, he may be able to sleep longer between feedings.
4. Stay out of extreme heat. Try not to take your newborn or young infant outdoors if it's very hot or humid. If you need to be outside, keep your baby in the shade and as cool as possible. Babies can also overheat inside in a hot, stuffy room, or if they're all bundled up. Try to keep your baby comfortable and breastfeed or offer a bottle very often to replace the fluids that he's losing.
5. Babies don't need water. You don't have to give your baby a bottle of water between feedings to try to prevent dehydration. Water fills the baby up and doesn't provide any nutrients. Both breast milk and infant formula provide your baby with fluid plus nutrition. If it's a very hot day or you think your baby needs extra water, you can give her an extra bottle or breastfeed her more.
6. Prevent the spread of germs that can cause illness. Wash your hands often especially before preparing your child's bottle and after changing diapers or using the bathroom. You can also remind family members and friends to wash their hands and ask them not to visit your child if they are sick, especially when your child is a newborn and young infant.
7. If your child is sick, has diarrhea or is vomiting, see your baby's doctor for treatment and monitoring. Do not stop feeding your child to try to stop diarrhea or vomiting. Your baby needs extra fluids to replace what she's losing, so continue to breastfeed or bottle-feed as often as possible while your child is ill and undergoing treatment.

Severe dehydration can be a very dangerous and even life-threatening situation for your baby. Call the doctor if your child:

• Is under three months old and has a fever
• Is not breastfeeding or bottle feeding well
• Has a sunken fontanelle
• Is vomiting after two feedings in a row
• Has diarrhea for more than eight hours
• Shows any of the signs of dehydration listed above

Babies lose body fluids during the day, and they get all the fluids they need to replace what's lost through their regular feedings. It's a natural balance. But, when there's a shift in that balance, a baby can become dehydrated. Dehydration can develop in a newborn or an older child. It can affect a breastfed baby or a child that takes a bottle. By understanding dehydration, its causes, and it's warning signs, you can try to prevent it or at least catch it early.

Mild dehydration is easy to treat by offering extra feedings and keeping the baby out of extreme heat. However, dehydration can become dangerous if the baby is not eating well or has an illness with a fever, diarrhea, or vomiting. If your newborn or infant is not breastfeeding or bottle feeding well, she's sick with a fever, vomiting, or diarrhea, or you notice any of the signs of dehydration listed above, you should call your doctor immediately.